Solov'ev G M
Kardiologiia. 1977 Nov;17(11):54-60.
Experience gained in the surgical management of 21 patients with atherosclerotic lesions of the aorta and arteries of the lower extremities treated by open endarterectomy extending for a distance of 20 to 70 cm is summarized. Only the outer coat of the artery and the external elastic membrane were preserved during open endarterectomy. A graft of autologous or allogenic vein was stitched into the incision made in the anterior wall of the aorta to repair it completely. In the distal portions open endarterectomy was supplemented by closed endarterectomy. In 2 patients with a follow-up period of 18 months thrombosis occurred at the site of the operation. In all the other patients patency of the reconstructed vessels was preserved. The author believes that the arterial bed should be expanded in such a way that no stenosed parts reducing the volume of the blood flow in the reconstructed artery should remain proximal to the zone of the reconstruction. The universal extraperitoneal approach to the aorta including thoractomy in the ninth intercostal space with the diaphragm cut off at the site of its attachment was used in 2 patients (with aneurysm of the abdominal aorta and Leriche's syndrome in conjunction with vasorenal hypertension). The conditions for and possibilities of applying allogenic veins in reconstructive operations on the arteries are discussed.
总结了21例接受开放式动脉内膜切除术治疗的腹主动脉和下肢动脉粥样硬化病变患者的手术经验，该手术长度为20至70厘米。开放式动脉内膜切除术仅保留动脉外膜和外弹性膜。将自体或异体静脉移植物缝合到主动脉前壁的切口中以完全修复。在远端部分，开放式动脉内膜切除术辅以封闭式动脉内膜切除术。2例随访18个月的患者在手术部位发生血栓形成。在所有其他患者中，重建血管保持通畅。作者认为，动脉床应以这样的方式扩张，即在重建区域近端不应残留任何会减少重建动脉血流量的狭窄部分。2例患者采用了包括在第九肋间进行开胸并在膈肌附着处切断膈肌的全腹膜外入路至主动脉（分别患有腹主动脉瘤和伴有肾血管性高血压的勒里什综合征）。讨论了在动脉重建手术中应用异体静脉的条件和可能性。
